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Levitra, a film-coated tablet, is indicated for the treatment of erectile dysfunction or the inability to achieve or maintain penile erection sufficient for satisfactory sexual performance. Each 5-, 10- and 20 mg tablet contains 5.926, 11.852 and 23.705 mg of Vardenafil monohydrochloride trihydrate, respectively.
Penile erection occurs with the relaxation of smooth muscle in the corpus cavernosum and its associated arterioles. During sexual stimulation, from nerve ends in the corpus cavernosum, nitric oxide is released, which activates the enzyme guanylate cyclase resulting in an increased level of cyclic guanosine monophosphate in the corpus cavernosum. This, in turn, activates smooth muscle relaxation, allowing increased inflow of blood into the penis.
By inhibiting PDE5, the enzyme responsible for cGMP degradation in the corpus cavernosum, Vardenafil potently enhances the effect of endogenous nitric oxide, locally released in corpus cavernosum upon sexual stimulation. Levitra thus potentiates the natural response to sexual stimulation.
The usual recommended doses are as follows: • Starting dose is usually 10 mg taken as needed approximately 25 - 60 minutes before sexual activity. In clinical trials, Vardenafil was shown to be efficacious when taken up to 4 - 5 hours before sexual activity. The maximum recommended dose frequency is once a day. Levitra can be taken with or even without food. For a natural response to treatment, sexual stimulation is required. • Range of dose depends on efficacy and tolerability, the dose may be increased to 20 mg or decreased to 5 mg. • 20 mg is the maximum recommended dose to be taken once a day. A maximum dose of 5 mg should not be exceeded when used in combination with the potent cytochrome P-450 inhibitors, ketoconazole, itraconazole, indinavir and ritonavir. A maximum dose of 10 mg should be exceeded when used in combination with erythromycin.